Epidemiol Infect. 2017 Apr;145(6):1239-1245. doi: 10.1017/S0950268816003368. Epub 2017 Jan 30.
- 1
- Health Protection Team,Public Health England,North West,UK.
- 2
- Field Epidemiology Service,National Infections Service,Public Health England,Liverpool,UK.
- 3
- Food Water and Environmental Microbiology Laboratory,Public Health England,Preston,UK.
- 4
- NIHR Health Protection Research Unit in Gastrointestinal Infections,UK.
Abstract
In August 2015 a gastroenteritis outbreak occurred following a wedding.
An outbreak investigation was undertaken and a cohort study was
conducted using an online survey. Of 140 guests, 134 received the survey
and 113 responded (84·3% response rate). Seventy respondents met the
case definition of vomiting and/or diarrhoea within 72 h of the wedding
(61·9% attack rate). Fifteen exposures were associated with illness; on
stratification, all were confounded by the ham hock starter.
Multivariable analysis showed a significant association with exposure to
ham hock (risk ratio 6·62, 95% confidence interval 2·19-20·03). Eight
guests and two catering staff submitted stool samples. All tested
positive for norovirus GI-6 infection, including a food handler who had
vomiting less than 48 h before the wedding.
A single genotype was detected among all samples, suggesting a single
source of contamination. The transmission pattern suggested point-source
exposure. The most plausible cause of the outbreak was transmission
from an infected food handler via contaminated food. This highlights the
importance of appropriate exclusions for symptomatic food handlers.
Additionally, the food handler's stool sample was submitted 7 days after
symptom resolution. The potential for extended viral excretion, and the
extremely low infective dose of norovirus, may mean that current
exclusion guidelines are not of sufficient duration.
KEYWORDS:
Caliciviruses; Norwalk agent and related viruses; gastrointestinal infections; outbreaks
Pan Afr Med J. 2016 Oct 1;25(Suppl 1):3. doi: 10.11604/pamj.supp.2016.25.1.6167. eCollection 2016.
Cholera outbreak following a marriage ceremony in Medinya, Western Ghana.
- 1
- Ghana
Field Epidemiology and Laboratory Training Programme, School of Public
Health, University of Ghana, Ghana; Veterinary Services Directorate,
Accra, Ghana.
- 2
- Ghana Field Epidemiology and Laboratory
Training Programme, School of Public Health, University of Ghana, Ghana;
Diseases Control and Prevention Department, Ghana Health Services,
Accra, Ghana.
- 3
- Ghana Field Epidemiology and Laboratory
Training Programme, School of Public Health, University of Ghana, Ghana;
University of Health and Allied Sciences, Ho, Volta Region, Ghana.
- 4
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Ghana.
Abstract
INTRODUCTION:
Cholera is a diarrhoea disease caused by the bacterium e.
On 13th June 2011, there was a reported outbreak of acute watery
diarrhoea at Medinya among people who eat at a mass traditional wedding
ceremony in the Western Region of Ghana. We investigated to
characterize the outbreak, and implement control and preventive
measures.
METHODS:
We
conducted a retrospective cohort study. We interviewed health workers,
reviewed medical records, conducted environmental assessment and
obtained water and stool samples for laboratory investigation. A
suspected cholera-case defined as a person with acute watery diarrhoea,
with or without vomiting, who ate food prepared at the mass traditional wedding in Medinya on 10th June 2011. We performed univariate and bivariate analysis.
RESULTS:
Of
the 17 case-patients, 9 (52.9%) were males. The overall attack rate was
11.18% and case fatality rate was 5.9%. The most affected age group was
6-10 years (23.53%) with median age of 20 and ranged 6 to 38 years.
Time of onset of symptoms was 2.00am and peaked at 10.am on 13th June.
Compared to other food served, fufu with groundnut soup was more likely
to have been contaminated (RR=7.3, 95%CI: 1.8-29.3). We isolated e serotype ogawa from stool samples. We observed open defaecation and poor personal hygiene.
CONCLUSION:
e
serotype ogawa caused a high case-fatality outbreak in Medinya.
Contaminated fufu and groundnut soup were the sources. Hand washing with
soap was initiated and a make shift latrine constructed following our
health education and recommendations.
KEYWORDS:
Cohort studies; Ghana; cholera outbreak; serotype-ogawa
